Zeng Yingjian’s Clinical Experience In Treating Immune Thrombocytopenia From Dampness

Objective:Director Zeng Yingjian,a mentor,has been engaged in hematological diseases for more than ten years and has a unique point of view on the diagnosis and treatment of Immune Thrombocytopenia.This article will summarize the common syndrome and treatment characteristics of the tutor in the treatment of immune thrombocytopenia from dampness theory on the basis of the past doctors’ understanding of ITP,so as to provide new ideas for the treatment of immune thrombocytopenia.Methods:To read and analyze the past physicians’ academic thoughts on the disease combined with the relevant works and literature of the tutor,and collect the medical records of the tutor Zeng Yingjian who was diagnosed as ITP and the syndrome judgment contained dampness.According to the inclusion and exclusion criteria,a total of 48 medical records were collected,with a total of 218 visits.Use Office Excel to establish patient data database and analyze the frequency of syndrome,prescription,drug and other data,summarize the common diagnosis and treatment and medication characteristics of tutor in the treatment of ITP.Results:1.Theoretical research results: the key pathogenesis of dampness syndrome ITP is: deficiency and excess,spleen and kidney deficiency is the main deficiency,rheumatism,dampness-heat,cold-dampness,dampness and blood stasis are common,dampness is the key.The tutor believes that rheumatism can induce the disease,and in clinic,most patients develop after respiratory tract infection,including rheumatism,blocking qi,depression and resolving heat,damp-heat fumigation of muscle surface,burns of blood collaterals mucosa,and purpura.The cold and heat of dampness is closely related to the rise and fall of human yang,Yin Sheng Yang deficiency leads to cold,spleen and kidney lose control,blood does not follow the pulse,resulting in bleeding,or Yang Sheng Yin deficiency,dampness is easy to turn from heat,damp-heat cross-steaming,fumigating blood collaterals,and even heat exuberant fire forces the blood to bleed.Damp pathogen blocks meridians,qi and blood is not smooth,qi stagnation is blood stagnation,blood stasis becomes blood stasis,dampness stagnation and blood stasis,blood stasis blocks pulse channel,blood does not return to meridian and purpura.In addition,the incidence of ITP is mostly related to deficiency of spleen and kidney and nostalgia of evil qi.As the Inner Canon of Huangdi saying "where the evil comes together,its qi must be deficient",tracing back to its origin,due to the deficiency of yin,Yang-heat,heat forcing the blood,or qi deficiency and loss of solid,it is difficult to ingest blood,blood overflow outside the pulse,purpura does not follow the regular way.Therefore,the tutor believes that damp pathogen is very important in the pathogenesis of ITP,which is not only the pathological product of the pathogenesis of ITP,but also an important pathological factor leading to the occurrence and development of the disease.2.Clinical research results:(1)Statistics of the frequency of syndrome types: 48 clinical medical records collected were divided into7 syndrome types.There were 15 cases of endogenous dampness-heat and spleen-qi deficiency syndrome,9 cases of damp-heat internal resistance and liver-qi stagnation syndrome,8 cases of cold-heat obstruction,spleen-kidney yang deficiency syndrome,6 cases of dampness-heat syndrome and liver-kidney yin deficiency syndrome,4 cases of dampness and blood stasis,liver depression and spleen deficiency syndrome,3 cases of rheumatism and heat entrapment and burn of lung collaterals,and 3 cases of dampness-evil depression and stomach fire syndrome.Among them,there were 42 cases of syndrome related to liver,spleen and kidney,accounting for 87.50%.(2)Statistics of the frequency of traditional Chinese medicine:among the 48 medical records(128 diagnoses),there were a total of 25 traditional Chinese medicines with a frequency of ≥ 20.Among them,Poria cocos has the highest utilization rate,accounting for 71.88%.The traditional Chinese medicines with a frequency of more than 50% are Poria cocos,Atractylodes macrocephala,Rhizoma Atractylodis,Bupleurum and Radix Paeoniae Alba.Among the therapeutic drugs,Poria cocos appeared92 times,Atractylodes macrocephala appeared 74 times,swollen wind appeared 69 times,Bupleurum 68 times,white peony 65 times,fairy crane grass 60 times,Rubia officinalis 59 times,yam 58 times,tangerine peel55 times,Fructus Aurantii 51 times,Codonopsis pilosula 51 times,licorice,roasted licorice 93 times and so on.(3)Statistics of the frequency of using prescriptions: most of the 48 medical records(128diagnoses)included were combined prescriptions.In order to facilitate statistics,the prescriptions were divided into unilateral prescriptions,and 31 prescriptions were obtained.Among them,Sini Powder,Liujunzi decoction,Wendan decoction,Erzhi Pill,Sanren decoction,Xiaoyao Powder,Liuwei Dihuang Pill,Fuzi Lizhong decoction,Erchen decoction and Mannan disinfectant Dan appeared more frequently.Conclusion:Through the theoretical research on the treatment of ITP from dampness theory and the clinical study of tutor in the treatment of "dampness" syndrome ITP,combined with the mentor’s clinical experience in treating ITP,the following conclusions are drawn:1.The tutor believes that the key pathogenesis of ITP of "dampness" syndrome is the mixture of deficiency and excess,deficiency of spleen and kidney,rheumatism,damp-heat,cold-dampness,dampness and blood stasis,and dampness is the key.2.The common ITP syndromes of "dampness" syndrome are: dampness-heat endogenous syndrome,spleen-qi deficiency syndrome,internal dampness-heat syndrome,liver-qi stagnation syndrome,cold-heat syndrome,spleen-kidney yang deficiency syndrome,dampness-heat internal exuberance syndrome,liver-kidney yin deficiency syndrome,dampness and blood stasis syndrome,liver depression and spleen deficiency syndrome,rheumatism clamping heat syndrome,burning lung collaterals syndrome,dampness evil depression syndrome and stomach fire syndrome.The frequency of drugs for tonifying deficiency and removing dampness is the highest,because most of the patients with "dampness" syndrome ITP are in chronic stage,and the syndrome is characterized by spleen deficiency and dampness stagnation,so it is mainly treated by warming and invigorating dampness.From the prescription used,Sini San is the most frequently used,which may be related to the fact that most of the patients with long course of ITP are accompanied by qi stagnation and pessimism,but the overall prescriptions are mostly used to remove dampness and replenish deficiency,so it can be seen that the clinical treatment of ITP is important.3.The clinical characteristics of the tutor in the treatment of this disease are as follows: focusing on the treatment of dampness,warming and tonifying dampness,clearing heat and dehumidification,dispelling wind and dampness,removing blood stasis and dampness;paying attention to qi depression and dampness,soothing the liver and invigorating the spleen;paying attention to the external features,there must be a way out for the treatment of dampness;and enumerated the pairs of anti-dampness drugs commonly used by mentors and single special drugs.The method of treatment is flexible and changeable,using multiple prescriptions,emphasizing both the symptoms and the root causes.